Asphalt fires, delirium, body bags: Extreme heat overwhelms US emergency rooms

In the 40 years that David Sklar has worked in the emergency room, he can name three times in his career when he was terrified.

“One was when the AIDS epidemic hit, the second was Covid, and now this,” the Phoenix doctor said, referring to the relentless heat in his city. Last month was the hottest June on record in the city, with temperatures averaging 97F (36C), and scientists say Phoenix is ​​on track to reach its warmest summer recorded this year.

“All three of these situations are kind of disasters, where we were overwhelmed by something that had really serious consequences for a large part of our population.”

In recent months, he and his colleagues have seen large numbers of patients arriving at the emergency room with heat stroke, dehydration and even asphalt burns.

He described seeing multiple patients in one shift with heat stroke. “Usually people aren’t talking at all, they’re breathing and panting and they’re in really bad shape,” he said of the most severe cases.

As the climate crisis worsens and heat records shatter, emergency rooms across the country are filling up with patients sick from the heat. included nearly 120,000 heat-related emergency room visits in 2023 alone, a “substantial” increase over previous years, the Centers for Disease Control and Prevention said.

At least 27 people In Maricopa County, where Sklar works, have died from heat so far this year, with hundreds of other deaths under investigation. But these numbers are likely underestimates, as heat-related deaths are often underestimatedespecially under outside workers.

“That’s the tip of the iceberg,” Sklar said. “We really need to start treating heat waves as a disaster.”

Extreme heat is not recognized as a disaster by the federal government. Earlier this month, 14 attorneys general, led by Kris Mayes of Arizona, petitioned the Federal Emergency Management Agency to declare wildfire smoke and extreme heat major disasters.

“We’re used to calling hurricanes, tornadoes, earthquakes disasters that can cause mass casualties, but in most cases they’re over quickly,” Sklar said. “(Heat) is a slow-moving disaster that lasts for weeks and months, and the people who get hit by it are just very sick.”

Heat is the deadliest weather disaster, which kills more people each year than hurricanes, floods and earthquakes combined. Last month, the warmest June ever recorded and in recent weeks, large parts of the US have been hit by record temperatures.

Health workers say the heat is putting pressure on already full emergency rooms. understaffed, overcrowdedAnd still struggling with the consequences of the Covid-19 pandemic.

“Our emergency departments are already overcrowded,” said Ellen Sano, a physician at Columbia University Medical Center. “So any time you add in the environmental impact of heat or a viral infection, we’re struggling with capacity.”

Earlier this month, millions of people in Texas lost power during a deadly heat wave after Hurricane Beryl made landfall. Power outages in some areas lasted more than a week, with local hospitals suffering a small increase in heat-related illnesses. Officials have a medical shelter in a local arena for patients who were ready to be discharged from the hospital but whose homes still had no electricity.

“There are so many patients we have to transfer because all of these hospitals are so full,” said Owais Durrani, an emergency physician in Houston. “When I park at the hospital, I see a line of ambulances around the corner. When you walk in, there are lines and lines of patients in the hallways and every bed is occupied. It’s scary coming to work.”

Durrani said the heat at night, combined with power outages, contributed to people getting sick. “You might have had a day where you exert yourself, you go home and drink some fluids, you have air conditioning and you can recover,” he said. “But there is no recovery if you don’t have power.”

Summers have become warmer on average since 1970 2.5Fwhere the temperatures at night are 3V in the US, according to Climate Central.

Children, the elderly, pregnant people, people who work outdoors, and people with chronic medical conditions such as diabetes and high blood pressure are most vulnerable to heat stress: an excessive buildup of heat at levels higher than the body can release. The homeless are another at-risk group, largely because of lack of air conditioning, prolonged exposure, and often unaddressed health conditions, many of which are exacerbated by heat.

“They sleep and live on the asphalt, and it doesn’t cool down as much at night,” said Durrani, who says he has seen patients come in with asphalt burns.

Some medication for chronic conditions can put people at increased risk of heatstroke. Amphetamines, which are often used to treat ADHD, can raise a person’s body temperature, and some antidepressants, antihistamines, and beta blockers can impair a person’s ability to cool down.

“People who take certain medications for psychiatric conditions, those medications can disrupt your sweating mechanism,” said Gredia Huerta-Montañez, a pediatrician and environmental health researcher at Northeastern University. “If you leave your medications in the car on extremely hot days, those medications can be altered and less effective.”

Sklar, the Phoenix doctor, said other underlying conditions — including untreated mental illness — also put patients at high risk. “Not taking medication can be a problem for people with schizophrenia because sometimes they make decisions that are not in their best interest,” Sklar said. “So they can just walk out and walk out and collapse.”

Treatment for heat illness varies depending on the condition of the patient admitted, but if someone is sick enough to be hospitalized, health care providers typically apply ice packs to the neck and groin — areas with high blood flow and also places where the body tends to sweat, Sklar says. Cool intravenous fluids can lower the body temperature while also treating dehydration.

Patients sometimes become so overheated that they become confused or lose consciousness, Sklar said. That often indicates heat stroke, in which the core body temperature can rise above 104 degrees Fahrenheit. In such cases, speed is of the essence, because the internal organs can start to fail.

In such cases, doctors sometimes place patients in body bags filled with ice.

“It turns out they’re actually relatively effective because they hold water really well and they’re the right size for a human body,” Sklar said. Emergency responders, including fire departments, use similar methods. “Because they’re unconscious, they don’t really feel the pain of the cold,” he added. “The key is to get them cooled down quickly.”